Abstract
AimsWe sought to evaluate the impact of ischemic burden for the prediction of hard cardiac events (cardiac death or nonfatal myocardial infarction) in patients with known or suspected CAD who undergo dobutamine stress cardiac magnetic resonance imaging (DCMR)MethodsWe included 3166 patients (pts.), mean age 63±12 years, 27% female, who underwent DCMR in 3 tertiary cardiac centres (University Hospital Heildelberg, German Heart Institute and Kings College London). Pts. were separated in groups based on the number of ischemic segments by wall motion abnormalities (WMA) as follows: 1. no ischemic segment, 2. one ischemic segment, 3. two ischemic segments and 4. ≥three ischemic segments. Cardiac death and nonfatal myocardial infarction were registered as hard cardiac events. Pts. with an “early” revascularization procedure (in the first three months after DCMR) were not included in the final survival analysis.ResultsPts. were followed for a median of 3.1 years (iqr 2–4.5 years). 187 (5.9%) pts. experienced hard cardiac events. 2349 (74.2%) had no inducible ischemia, 189 (6%) had ischemia in 1 segment, 292 (9.2%) in 2 segments and 336 (10.6%) ≥3 segments. Patients with only 1 ischemic segment showed a high rate of hard cardiac events of ∼6% annually, which was 10-fold higher compared to those without ischemia (0.6% annually, p<0.001) but similar to those with 2 and ≥3ischemic segments (∼5.5% and ∼7%, p = NS).ConclusionsThe presence of inducible ischemia even in a single ‘culprit’ myocardial segment during DCMR is enough to predict hard cardiac events in patients with known or suspected CAD.
Highlights
IntroductionStress induced myocardial ischemia exhibits significant prognostic information in this population cohort, surpassing the prognostic value of conventional atherogenic risk factors [2]
Estimating the risk of subsequent cardiac events is of paramount importance in patients with known or suspected coronary artery disease (CAD), because an invasive therapy is warranted for patients with myocardial ischemia who are at high-risk for future events [1]
Similar sensitivity and specificity were reported in detecting ischemia induced wall motion abnormalities (WMA) for dobutamine stress echocardiography (DSE), nuclear perfusion imaging and highdose dobutamine stress cardiac magnetic resonance (DCMR) [3, 4, 5], the latter offers the advantage of excellent spatial and temporal resolution and can be performed without ionizing radiation and even without the need for contrast agent administration for the patients
Summary
Stress induced myocardial ischemia exhibits significant prognostic information in this population cohort, surpassing the prognostic value of conventional atherogenic risk factors [2]. Similar sensitivity and specificity were reported in detecting ischemia induced wall motion abnormalities (WMA) for dobutamine stress echocardiography (DSE), nuclear perfusion imaging and highdose dobutamine stress cardiac magnetic resonance (DCMR) [3, 4, 5], the latter offers the advantage of excellent spatial and temporal resolution and can be performed without ionizing radiation and even without the need for contrast agent administration for the patients. The extent of ischemia was shown to carry prognostic value in patients undergoing DSE. In this regard, patients with $3 segments with WMA exhibit high-risk for subsequent cardiac events [6]. Current guidelines translate these findings to other imaging modalities, until now no data are available related to the prognostic value of ischemia extension for DCMR [7]
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